Appendix 1 - Form for New Application as an Environmental Auditor

(Instruction: type or write clearly in black colour; leave no blanks. Write N/A for non-applicable. Incomplete, wrong or vague
information could subject to rejection. Note that non-Malaysians are not eligible to apply and register.)

(1) Type of Environmental Auditor (a) External (b) Internal (c) Non Applicable
Applied: (Please mark with (√)) Environmental Environmental – Attend Training
Auditor Auditor Only
(2) Type of Environmental Audit Applied: (a) Environmental (c) Environmental
(b) EMS Audit
(Please mark with (√)) Compliance Audit Risk Audit

Full Name (Surname, Given Name)

Title
Mycard Number
Date of Birth (date, month, year)
Gender (Male/Female)
Organization Name
Position/Job Title
Postal Address (number, street name, postcode, city/town, state, country)
__________________________________________________________________
_______________________________________________________ Recent passport-sized

Telephone (office): _______________ (home): ______________ Photograph

Mobile phone: ___________________ Fax: ________________
Email: (paste firmly here)
Details of Credentials
(Instructions: Use the forms in Appendices 3, 4, 5, and 6 to fill in your academic,
professional membership, training and seminars attended, audit and work experience.
Attach completed forms and copies of certificates/documents together with this form.)

References: (Fill in 2 references from 2 different organizations who can be reached to verify your personal attributes,
education, training, work and audit experience)
1. Name:________________________________ 2. Name_________________________________
Address: ______________________________ Address: ______________________________
______________________________________ ______________________________________
______________________________________ ______________________________________
Tel: _______________ Fax:________________ Tel: _______________ Fax: _______________
Email:__________________________________ Email: _________________________________
Stamp/Date/Signature: Stamp/Date/Signature:

Declaration: I certify that all information contained here are true and accurate to the best of my knowledge. I abide by the
codes of conduct and all the requirements in the Natural Resources and Environment (Audit) Rules, 2008 and Guidelines, and
any wrong or false information in this application form can lead to rejection of my application.
Signature: Date:

Checklist: (tick boxes below to ensure the application is complete)

Form completed Payment attached: state cheque no and amount:________________________
Complete Documents/certificates attached
For NREB use only
1. Date received: 2. Fees correctly paid? Y/N 3. Documents complete? Y/N
4. Decision: Approve/Reject Reason:
5. Reviewing officer name/signature/date:
 Appendix 3 – Academic Qualifications
(Complete your information on education background, starting from latest received till certificates)

Full Name

Year of Full or part Full title received Name and address of school or Grade obtained Description of subjects/topics
graduation time (e.g. Master of Science in university or institution (e.g. First class or studied
Environmental Science) CGPA=4.00) (list subjects or attach results transcripts)

I declare that all the above information is correct and accurate, with the understanding any wrong information can lead to rejection or return of my application.
Signature: Date:

For NREB use only

1. Form/attachments complete? Y/N Reasons:
2. Verifications satisfactory? Y/N Reasons:
3. Name and signature of Officer/Date:
 Appendix 4 - Professional Qualifications and Memberships
(Complete your information on professional affiliations, starting from latest received. Attach certificates/documents as evidence)

Full Name

Full name of Professional Body Official Address, Telephone, Fax, email and website Current membership grade
abbreviation Title/Grade Date
achieved

I declare that all the above information is correct and accurate, with the understanding any wrong information can lead to rejection or return of my application.
Signature: Date:

For NREB use only

4. Form/attachments complete? Y/N Reasons:
5. Verifications satisfactory? Y/N Reasons:
6. Name and signature of Officer/Date:
 Appendix 5 – Relevant Training Received
(Complete your information on public/in-house training attended, starting from latest received. Attach certificates/documents as evidence)

Full Name

Title of training Duration and Venue Details of training provider or seminar organizer Title of certificate
or seminar Date (e.g. 3 Name Address, telephone, fax, email and website (e.g. Certificate of
attended days, 10-12 Jan. Attendance)
2011)

I declare that all the above information is correct and accurate, with the understanding any wrong information can lead to rejection or return of my application.
Signature: Date:

For NREB use only

7. Form/attachments complete? Y/N Reasons:
8. Verifications satisfactory? Y/N Reasons:
9. Name and signature of Officer/Date:
 Appendix 6 – Relevant Environmental Auditing Experience
(Complete your information on auditing experience, starting from latest received. Attach documents as evidence)

Full Name
No. Type of Duration Role in the Number of Details of Auditee Description of
audit (e.g. and Date of Audit Team auditors Name of Industrial Address, telephone, fax, auditing work
Environmental On-Site (e.g. Audit (and name organization sector (e.g. email, website
Compliance Audit (e.g. 3 Team member) of leader) plantation)
and person-in-
Audit)
days, 10-12 charge
Jan. 2011)

I declare that all the above information is correct and accurate, with the understanding any wrong information can lead to rejection or return of my application.
Signature: Date:

For NREB use only

10. Form/attachments complete? Y/N Reasons:
11. Verifications satisfactory? Y/N Reasons:
12. Name and signature of Officer/Date:
Appendix 8A – Flowchart for Registration of External Environmental Auditor

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Submission of application document

- Application fee (RM50)
- Forms in Appendices 1,3,4,5 and 6 in Guidelines
- Curriculum vitae (CV): working experience

No Document
complete?

Yes

No Appeal within 2
Qualify?
Notification letter from CEQ months

Yes

Attend Training and examinations Yes

- Examination fee (RM 200) Qualify?
- Training fee (will be informed prior to training)
Fail

No
Fail
Re-sit Pass?

Yes
Pass
Fail Fail
Interview
Re-Interview
by panel

Pass
Pass
Panel recommend for registration

Issuance of certificate upon successful

registration and payment of registration fee
(RM 250)

END